HomeMy WebLinkAboutDrain Layers Permits 31 Wentworth Drive 1900003 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/04/2019
GIS ID: 93300031 FEE: 80.00
MUNIS APPLICATION# 201900013 EXPIRATION DATE: 02/03/2019
APPLICANT LOCATION
NAME: FOLSOM CONSTRUCTION LLC ADDRESS: 31 WENTWORTH DRIVE
ADDRESS: 138 RYE STREET OWNER: BRASSARD SANDRA M
3I WENTWORTH DRIVE
SOUTH WINDSOR,CT f?6074
PHONE 860-5281.8928
WORK DESCRIPTION: SANITARY REPAID
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUED BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTIS IN THE"ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAItS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
1/4/2019 11:43 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: - C%kv13 CONTRACTOR: 1 d ISO In
LOCATION:
TYPE OF WORK: Azurw �'� ���► ('�
DATE INSP NEEDED: DATE INSP: / �-7
INSPECTED BY: L%
WORK IN
PROGRESS: �� .-
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5*mo fibrm 2m Town of Soffit Wig I TDDw REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: 31
Lot #
Street No. Street Name
Premises owned by: LGp.1 �j r� 55a1
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Name of Firm:_ aa �o�/J�i�� Phone: CK'b d
Address of Firm:
TYPE OF WORK.-
Lay House Drain , Repair House Drain_; Sanitary Disconnect
Lay Lateral for building with connection- or no connection
Lay Main_
Lay Lateral for Commercial/Industrial Building - number of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for completion
ALL WORK M BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED To THE PERMIT
Permit is to.be issued to the holder of Drain
Layer's License No. 2-17 95� _, Only holders of P-1.. P-7 or W 9 licenses
Will be issued a permit. PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms
and conditions set forth in the permit and attached thereto. Applicant has received
Town Street Excavation Permit No. - and/or ConnDOT Permit No.
CBYD No. _20111 ( 1 01 (1 ZI PLEASE NOTE:
IF A SANITARY SEWER LATERAL
04 Cc J '� IS WITHIN 73 FEET OF A WELL
IT MUST BE.AIR TESTED .
Signed: Print Name:_
n D in Layer
Date: I r 3—
Standard ftM\P ffrft MCAnON FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ,o f
BUILDING ADDRESSf
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) h NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET SIGNATURE
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TOWN STATE ZIP
_ INSPECTED BY TOWN
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TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER